Japanese Response to Covid Sanitary Crisis: 7 Cardinal Sins

Early 2021 in a Trough

⏱ 10 minutes

One year after the discovery of the first Coronavirus 🦠 cases in Japan, the health crisis is lingering and unveils issues that had not impacted Japan yet. The winter uptick, enhanced by the new virus strains, highlight the usual Japanese difficulty to tackle a crisis without preparation: whereas Japan is excellent once the processes exist, it still lacks the capacity for improvising.

We have listed below, in a (mostly) chronological order, the 7 major errors Japan did in the management of Covid-19 crisis.

1️⃣ An overly low testing

We said it countless times in our Covid-related articles: Japan is one of the developed countries that tested the less in the world. The situation recently improved however, but the 100,000 tests per day threshold was reached only in mid-January. As a comparison, France did an average of 6 times more tests per inhabitant in the meantime (and consequently, a lot more in 2020).

As a matter of fact, unlike countries like France tests are not free in Japan. Until autumn and the opening of testing centers performing for ¥2,900 (~US$19.07) in largest cities, the price of a Covid-19 test was:

¥7 to ¥8,000 (~US$46.03 to ~US$52.61) for an antigenic test,
And an average of ¥25,000 (~US$164.40) for a PCR test!

The consequence of the low testing is the same as burying one’s head in the sand: fewer the numer of cases reported, the better the official numbers of infections…

2️⃣ Foreigners as scapegoat

We wrote a long article in January explaining how xenophobia is "used" in Japan, sometimes unconsciously, to explain the rise of cases in the archipelago and justify some of the country’s restrictive policies.

In the wake of the state of emergency declaration in early January, the Japanese government decided on two main policies regarding that matter (there is one good and one bad news):

Japanese citizens must – at last! – get tested and self-isolate during 14 days when returning in Japan,
Foreign residents who do not comply with the 14 days self-isolation may have their residency permit terminated.

Fortunately, foreign tourists will not be impacted when they come back after the crisis, as they will benefit from the Japanese omotenashi hospitality, unlike the expatriates.

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3️⃣ GoTo Travel to foster virus spreading

As we already said, the "GoTo" campaign is akin to the Japanese government’s own Frankenstein monster (let us not even consider the dubious English naming of the campaign): in order to revive a tourism industry battered by the strict closure of the borders, and against the growing opposition of medical professionals, the Japanese state sponsored about 30 to 50% of the Japanese’s leisure travel expenses in their own country since summer 2020.

The exponential growth of cases followed three steps:

Gradually and steadily since the beginning of the campaign,
During holidays and long weekends of the second half of 2020, with domestic airports overcrowded,
During koyo 🍁 season, in November and early December.

Even more than "GoTo Travel," "GoTo Eat" especially angered physicians. Many countries in the world have indeed closed restaurants during the pandemic peak as they are the second place of contamination with Covid-19 after home. But Japan decided to encourage its population to go to the restaurants and mingling in places where it was difficult to wear a face mask 😷, while footing part of the bill.

It was not until early December and the worrisome increase in the number of cases that Prime Minister Suga finally allowed to pause the campaign just before Christmas, then declared the state of emergency. Which did not prevent some of his colleagues to spend time in Ginza's hostess bars until late at night...

It is unknown if the "GoTo" campaign will be revived later, but it is a possibility, without any logic unfortunately. Let’s hope it will not resume mid-March for the sakura 🌸 season…

4️⃣ Few hospital beds available and many care denials

It may seem counterintuitive, but Japan can boast one of the largest hospital bed pools in the world with 13 intensive care unit beds per 1,000 inhabitants (twice as much as France and 4 times more than the United States). However, the majority of these beds belong to private hospitals, which is not alarming per se, except that many of them refuse Coronavirus confirmed cases patients, in fear of two things:

The creation of a cluster in the hospital, which would cause a 2 to 3 weeks administrative closure and humongous costs (disinfection, paying salaries to employees who cannot work, revenue loss…),
The diversion of non-Covid patients toward another hospital.

It seems that only 20% of private clinics beds are used during the pandemic. The occupation rate only increased since fall and the congestion growth in many prefectures is very concerning. Since a few months, in the most affected areas such as the greater Tokyo, Osaka or Fukuoka, ambulances transporting Covid patients can be rejected by several hospitals successively and must sometimes bring back the patients home, as they fail to find a welcoming hospital.

Over the last weeks, many Japanese died of severe forms of the disease at home (or committed suicide), and the government just started to address the problem with a law modification to force private hospitals to take in these patients. But this will not solve the problem of the current nursing shortage for intensive care units, which make experts fear a "collapse of the medical system."

5️⃣ A tardy and undersized winter state of emergency

100 deaths in one day. Compared to many other countries, the figure is relatively low but this symbolic threshold was crossed for the first time on 19 January 2021 and alarmed many Japanese and observers.

Beside the GoTo campaigns we already mentioned and the population’s fatigue that make it reluctant to accept the instructions (as anywhere in the world), the cause is an insufficient sanitary response from the political powers:

79% of Japanese people think that January 2021 state of emergency was declared too late,
78% think that it should be extended to the whole country like spring 2020’s one and not limited to some prefectures.

In the meantime, when the number of cases is dramatically increasing in the archipelago, the neighboring South Korea (where contamination curbs followed the same ascending path in December) has succeeded in bending the curb while still performing 2,5 times more tests than Japan.

Even on the side of financial help, the Japanese government is bogging down with the persistence of providing the same level of subsidies regardless the size, for example, of restaurants (as a reminder, their only instruction was to stop service from 8 p.m.!). As a matter of fact, the ¥60,000 (~US$394.50) subsidy per state of emergency day is generous enough for a neighborhood eatery, but is close to insufficient for large chains, that only obey instructions in fear of public judgement.

In mid-January, more than 2/3 of the population was not satisfied with the sanitary response of the Japanese government, a thorn in the side of PM Suga before September’s elections.

6️⃣ The vaccination campaign’s incredible delay

Complaints emerged in countries like France whose vaccination campaigns have not started before late December. However, looking into Japan’s situation can be comforting as with the oldest and more fragile population, it will be one of the last developed countries (along with South Korea and Australia) to start a vaccination campaign. It is indeed not scheduled before the end of February! One of the reasons behind this delay is that Pfizer’s vaccine will receive authorization from mid-February.

As of today, the tentative schedule is the following (yet to be validated by Kono Taro, on the front picture, the Minister for vaccine deployment, who does not like having his name reversed in newspapers):

Medical professionals (4 million persons) by the end of February,
Elderly people of 65 years and older (36 million) by the end of March,
Persons at risk / with co-morbidities (8,2 million) and elderly people aged between 60 to 64 years old (7,5 million) by the end of April,
The rest of the population (except people younger than 16 years old, who account for 18 million) between May and July.

Overall, ~55 million persons to vaccinate against Covid-19 in a little bit more than 2 months, or in other words about 1 million of vaccination per day, a quite optimistic pace… and provided, of course, that the long-ordered AstraZeneca and Pfizer vaccines (310 million doses, more than the overall Japanese population) are delivered on time.

7️⃣ A deficient protection of the Olympic Games

Despite the improvement of knowledge on the virus, the world sanitary situation is worse than last year, when the decision to postpone the Olympic Games 🏅 by one year was made.

As of today (6 months before the scheduled beginning!), 4 scenarios have been studied for the delayed Tokyo Olympic Games:

Best-case scenario (very unlikely): the situation quickly improves and the Games can start as scheduled on July 23,
Optimistic scenario: the Games are saved, but the number of spectators is limited, or the Games are held without public for sanitary reasons,
Worst case: the Olympic Games are cancelled, a second occurrence in their history (the first one in 1940 was also in Japan!), an awful setback for Japan whose rival Beijing is still supposed to host the Winter Games in February 2022,
Last hypothesis currently gaining momentum: a new postponing to… 2032(!), as 2024 was attributed to Paris and 2028 to Los Angeles. If the decision is approved, the next Tokyo games would take place 11 years in the future, a span longer than the time between the announcement and today (nearly 8 years since mid-2013).

These possibilities make the headlines of the world medias. Surveys found that 80% of the Japanese population if favorable to a new postponing or even to a simple cancellation. Meanwhile, some Japanese politicians and even IOC officials begin to consider the worst-case scenario. The athletes’ vaccination will not be mandatory, but regardless they might lack in preparation (especially depending on the conditions of the national selections) for the four-year sport event.

Such an important decision cannot be made on the last minute and it is likely that an announcement will come up quickly, probably by March, as the Olympic Torch Relay is supposed to start on March 25 in Fukushima prefecture. The state of emergency might still be enforced by then.
However, Japan’s Prime Minister Suga has already prepared good excuses in the event of the Olympic Games cancellation: it would be due to the defection of American athletes, which would consequently prompt the sponsors’ defection.

Not everything is Japan’s fault, but the officials’ communication was quite poor, from self-persuasion to public lies until very recently.

👍 Japan’s successes in the fight against Coronavirus

As a matter of fact, there are also bright spots in the picture, with many Japanese successes the fight against Covid-19:

A self-protection naturally implemented and enhanced: social distancing, wearing a sanitary mask, rise of telework…
An enhanced general hygiene: adaptation of public spaces and shops, with for example, body temperature and fever check before entering,
A general respect of the rules by the population (on the professional and individual levels), even when no state of emergency is declared,
A low number of cases during a long period of time, which delayed the difficulties mentioned above until the 3rd wave.

And that is what makes the current situation all the more lamentable: Japan could have used these long months as a preparation (even though anything could still happen) to better face the likely winter uptick, but failed to take advantage of them. Today seems like The Groundhog Day, with a situation surprisingly similar to 2020 early months: we still don’t know if the Olympic Games will take place and how long borders will stay tightly closed.

Certainly, no government succeeded perfectly in tackling the Coronavirus crisis, but the nationalistic and proud attitude Japan displayed over the last few months have probably not produced the desired results, on the contrary. Let us hope the country will find some humility to continue tackling a crisis that has been dragging for too long for everybody.